| NPI | 1831450139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 20A12368) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS11549) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV DO1990) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA OS020921) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2023-10-27 |